Abstract
Purpose To evaluate a peripherally inserted central venous catheter (PICC) repositioning protocol involving use of vigorous saline flush technique for correction of malpositioned PICCs placed at bedside. Materials and Methods All episodes of PICC tip malposition on post-bedside placement CXR over a 12 month period were reviewed. Data were prospectively collected at time of repositioning flush technique. Our protocol for malpositioned PICC begins with fluoroscopic evaluation of the PICC. If the PICC is too long or short or if it is coiled within an arm vein, saline flush is not attempted. Otherwise, if malposition is confirmed, vigorous saline flush technique using a 3mL polycarbonate syringe is performed under fluoroscopic guidance. If unsuccessful, the patient is then prepped and an attempt is made to exchange the PICC over a wire. Results 94 patients were included. In 5 (5%) there was spontaneous repositioning of the catheter without need for intervention. In 25 other encounters, flush repositioning was not attempted. Of the remaining 64, 30 (47%) were successfully repositioned with saline flush (Table). In the successful cases, the mean number of flushes required to reposition the PICC was 3 (SD 2, range 1-6). Out of all of the catheters, 46 (including those PICCs that were not attempted to be flushed and those that failed flush) were successfully replaced over a wire, 8 required a new venous puncture, 3 were left as midline catheters due to inability to thread the catheter centrally and 2 were pulled back and secured with a box clamp because they were too long. Mean fluoroscopy time for successful repositioning using flush technique (0.8 minutes SD 1.0) was significantly less than for those requiring wire manipulation (4.1 minutes, SD 5.3) (p Conclusion Vigorous saline flush technique is effective for correction of roughly half of selected malpositioned PICCs. It can reduce patient radiation exposure. It is most likely to be successful if the PICC is not coiled and if the tip is in the ipsilateral internal jugular vein. Table 1
Published Version
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